The Principles and Techniques of Benefit-Finding for Dementia Caregivers: Reply to Gersdorf

Abstract

Using cognitive reappraisal to promote positive gains is a distinctive feature of the benefit-finding intervention (BFT). However, the intervention would not appeal to caregivers if it burdens them with extra training sessions, on top of a usual psychoeducation program.Furthermore, because the challenging aspects of dementia care (e.g., dealing with neuropsychiatric symptoms and impairments in activities of daily living) 1 provide exactly the context for searching for meanings, 2 positive reappraisal exercises are embedded within related topics when these challenging aspects are discussed, instead of being covered in stand-alone sessions. 3 This is probably more acceptable to caregivers as they come mainly for knowledge and care skills.BFT is often compared to cognitive-behavioral therapy (CBT) 4 because of the common focus on cognitive reappraisal, but in fact it departs from CBT in important ways. Although the role of dysfunctional thoughts is discussed initially in BFT as a way to illustrate the impact of thoughts on behaviors and emotions, the emphasis quickly shifts to reappraisal and discovering positive gains rather than exploring and confronting dysfunctional thoughts. 3,5 As Gersdorf 4 has rightly pointed out, this approach avoids the perception that the caregivers are "being fixed" in a psychotherapeutic context and increases the acceptability of the intervention. Moreover, CBT aims at correcting distorted thinking by realistic appraisal, not positive appraisal, 6 whereas positive reappraisals are the focus of BFT.In BFT, caregivers are asked to use cognitive reappraisal to serve the purpose of finding positive implications for oneself. For example, a spouse caregiver whose wife complains that he is seeing another woman may also treasure the fact that his wife still cares about their marital relationship after so many years. It does not lessen the wife's delusion but may reduce his anger when being accused. More examples can be found in earlier articles. [7][8][9] To help participants see the "benefits of benefit-finding" and to provide models of Page 2 of 7 positive coping, three caregivers (a daughter, a daughter-in-law, and a wife) who had coped well shared their experiences in pre-recorded videos. 3 In order to enhance the likelihood that the participants would resonate with the stories, both difficulties and positive gains were covered in the videos. Hearing it directly from those in the same boat would be more convincing than listening to the trainer alone. We were not able to find male caregivers to record such videos; this is an aspect that can be improved in the future.While the stories in the videos were encouraging, participants needed to build up confidence and competence in using positive reappraisal to reframe their situations on a daily basis. The emphasis is not on realistic thinking here as in CBT, 6 but on the ability to engage in alternative thinking. Even if a caregiver can find an alternative cognition to replace the current one, the ultimate goal of the training would be for the ca...

Long-Term Outcomes of the Benefit-Finding Group Intervention for Alzheimer Family Caregivers: A Cluster-Randomized Double-Blind Controlled Trial

“…Readers are referred to articles by Cheng and colleagues for further details, including specific techniques used to promote alternative thinking and benefit-finding. 5,7,8,12,13 Nevertheless, these were preliminary conclusions because the previous reports covered post-intervention (2 months from baseline) effects only. It is necessary to examine whether the effects lasted beyond the intervention.…”

“…Benefit-finding intervention 4 traditional CBT paradigm, 7 the benefit-finding therapeutic (BFT) intervention belongs to this category.…”

“…helper-therapy principle) were elaborated by Cheng. 7 A distinctive feature of BFT is to use cognitive reframing to reappraise difficult situations along positive lines, and to integrate such reframing exercises into the psychoeducational program. Caregivers are asked to reappraise challenging situations, such as when dealing with paranoid delusions or incontinence, in positive ways and in as many different ways as possible.…”

“…7 It is believed that this strategy helps to reduce stigma and increase participants' acceptance of the intervention by minimizing their perception of being -fixed‖ psychotherapeutically. 7,11 BFT does not monitor whether participants give up their dysfunctional thoughts but instead aims to cultivate in them the ability to think alternatively and positively so that they would not fixate on negative cognitions. Moving away from the traditional CBT paradigm allowed the use of non-professional psychology graduates as trainers, thus reducing costs.…”

“…21 The BFT, on the other hand, is identical to STD-PE but includes also training and exercises for positive reappraisal and benefit-finding using videos, hypothetical scenarios, personal stories/journals, group sharing and inter-subgroup contest. 5,7 Thus, while SIM-PE provided a minimally active control, STD-PE provided a more rigorous control and a reference point for whether benefit-finding is helpful.…”